From the Bizarro Department, the penny-pinching, smaller-government Obama Administration continues to look into saving money by closing the Veterans Administration facility in Hot Springs:
...the VA is moving forward with an environmental impact study on closing the century-old historic Hot Springs facility — a medical treatment and rehabilitation center with inpatient and nursing home units — and rebuilding in Rapid City.
...The VA says an economic analysis has shown that restructuring its facilities in western South Dakota would be cheaper and more efficient than trying to fix the aging facilities in Hot Springs. The environmental impact study is required by law to look at the plan's environmental, social and economic effects ["VA to Do Study on Closing Hot Springs Facility," AP via Black Hills Pioneer, 2014.01.08].
The closing appears unrelated to the federal facility's outburst of secessionism last spring. Rather, the VA seeks to improve access to services:
The VA’s Black Hills Health Care System proposal, the Veterans Department said, was to enhance the delivery of high-quality, safe and accessible care closer to veterans in parts of four states [Christopher Doering, "VA ADvances Closure of Hot Springs Facility," that Sioux Falls paper, 2014.01.08].
South Dakota's liberal Congressional delegation is outraged at this move toward more efficient service provision and demands bigger federal spending in health care:
"I am deeply disappointed that the VA is now looking to move forward on a plan that many South Dakota veterans are adamantly opposed to and that could jeopardize the care those who have fought for our country need and deserve," [Congresswoman Kristi] Noem said in a statement [AP, 2013.01.08].
In defense of the Hot Springs VA facility, local government-run health care activist Patrick Russell launched this broadside against private sector health care:
Russell noted that closing the Hot Springs facility will mean “veterans will travel farther to wait in longer lines to receive their care. Or they will be forced to obtain their care in private sector facilities that do not have the capacity to care for more patients or the knowledge, skills and abilities to diagnose or treat illness and injury common to wounded warriors” ["VA Opts to Move Forward with 2011 Plan," Rapid City Journal, 2014.01.08].
Expect Noem to face tough questions from her 2014 election challenger about her defense of costly, inefficient government-run health care.
This might be the only issue on which Kristi and I agree: Hot Springs is a great town and transforming the VA facility into an area health care center that integrates IHS with veteran wellness makes sense to me.
So, on one hand, Ms NOmer is willing to take billions of dollars in food stamps from our poor, disabled, and needy veterans throughout America without any question whatsoever and on the other hand, wants to spend billions to keep Hot Springs open for a few veterans. If you take a look at the maps of locations of where VA hospitals are, you will see that there is a huge area that there are no facilities whatsover. These veterans have to travel a long way to get to the VA and they do it each and every day. Here in western South Dakota, we now have three facilities all within a hundred miles of each other.
The new plan is to build a large center in Rapid City as a center much like Omaha or Minneapolis. That looks to me like a better idea to save money and to save lives with better treatment for veterans.
Larry and Jerry you both make great points. I tend to be for the VA facility in Hot Springs.
But this shows what a hypocrite Noem. As Jerry said she votes to take away money from the poor and vote 40 + times to repeal the ACA and take away insurance from people who either can't afford it or can't get it.
You have to wonder why people in this state can't see this?
Intersecting with white flight from the state, Wyoming's legislature is learning that insuring more people leads to lower health care costs: something completely lost on Noem.
http://wyofile.com/ron_feemster/wyoming-health-care-cost/
A new facility in RC? Now what will that cost in our currently nearly worthless dollars? Who would you bet will be running it? Can you say Regional? Thought you could. Looks like the fix is in!
Close it. The VA is correct. Imagine having 3 VA facilities within 60 miles of Sioux Falls and one grasps the wastefulness and inefficiency of VA healthcare delivery in the Black Hills region.
The property can't be transferred from federal ownership with congressional approval: "The original building complex from 1907 is in the radial or panoptical hospital design. The Sanitarium is included in the Hot Springs, South Dakota Historic District which is listed in the National Register of Historic Places."
http://www.nps.gov/nr/travel/veterans_affairs/Battle_Mountain_Sanitarium.html
The Hot Springs hospital also serves people from Nebraska and Wyoming. It is not just a facility for the Black Hills. My guess is also that older veterans find it a lot easier to get around in Hot Springs than in Rapid City poorly marked streets and traffic.
We have veterans traveling from North Dakota , Wyoming and Montana as well as places like Mobridge and Eagle Butte to Fort Meade at present. No one seems to be saying that there should be a VA hospital built in Reva so old veterans can get around better. This is all about resources. The VA has never been fully funded, ever. If Ms. NOemer and the rest want to do so much, why won't she use her power and persuade the House to draft a bill that would fully fund the VA perpetually? That way, there would not be the crisis that happens when a Democrat is not the president of the United States. All we have do is look at what happened at Walter Reed to see that if you do not keep these old relics up to standards, your operating funds are not adequate. The place is not up to current standards and it would cost too much continually to keep in up to hospital standards. Consolidate into the Rapid City Campus would make more sense and give a more professional degree of service to veterans from all over.
I am a Vet and a retired VA employee. There are three VA Medical Centers in South Dakota. They are Sioux Falls, Hot Springs, and Ft. Meade. Rapid City has an outpatient clinic with no on site lab or x-ray services. (http://www.va.gov/directory/guide/region_flsh.asp?map=0&ID=23)
The VA Medical Centers provide 24/7 emergency rooms along with inpatient care. Hot Springs has been in a slow downsizing mode since the mid 1980s. The change in the way health care is delivered with an emphasis outpatient care and emphasis in short hospital stays has cut the need for space. We also have a decline in the number of vets despite the many conflicts past and current. President Bush in January 2003 cut off thousands of WW-II and later vets from VA care if they were not already enrolled due to budget constraints. President Obama relaxed the requirements slightly during his first term.
The proposal to close Hot Springs would save the VA millions of dollars annually.
The savings come from;
No longer having operating costs for maintaining the old buildings, central heat plant, roads and grounds, police force, fire department, and numerous other support services.
Staff reductions as there will be no more inpatient care.
The proposal would be to build/lease a VA run outpatient clinic run as a Monday to Friday operation. Emergency /Urgent care could be contracted with Fall River Hospital. The VA would not have to do the maintenance on a leased building. The City Of Hot Springs would be responsible for Police and Fire. The VA probably would not pay for those services as it is a federal agency.
The Rapid City proposal would be another outpatient clinic that could provide the onsite services lacking in the current facility. It would not include inpatient care.
Note that Montana has one VA Medical Center at Ft Harrison and North Dakota has one VA Medical Center in Fargo. The rest of those states are covered by VA contracted Community Based Outreach Clinics (CBOCs).
I fully support Hot Springs in their efforts but I will guess that in 10 years the VA Medical center will be replaced by a clinic. The VA emphasis is on putting money in the large cities with many veterans. Rural areas like South Dakota do not meet those criteria. I would not be surprised to see a proposal one day to build a new medical center in Sioux Falls and close Ft Meade and Hot Springs.
I wonder how Thune and Noem can support the Hot Springs VA on one hand and yet claim that we need to cut government and the government does not create jobs but yet express concern about jobs lost by closing a federal office.
Noem flips and flops to protect her milk cow. She must wake each morning and check the wind direction hence the trench coat and cowboy boots.
@WR Old Guy, well said.
Next year if SD has a GOP-only congressional delegation Ellsworth will be closed as well. It has been on the chopping block twice, and only because we had congressional members from both parties was it saved. When we have 3 GOPpers complaining about federal spending watch them whine when their own portion gets cut. If Rounds wins, kiss Ellsworth AFB goodbye before President Obama leaves office.
@WR Old Guy as you retired from the VA, am I correct in that there was a new building that was built on the campus of Camp Rapid that was supposed to be for a veterans as an outpatient clinic? This building faced Sheridan Lake Road.
Perhaps all special veterans care centers should be closed and veterans should get same quality care via an expanded option in Obamacare. Same for care of Native Americans.
I am guessing that you are not a veteran Douglas so you probably do not know what all is involved in a "special veterans care center". In addition to a hospital, they are also a center for veterans to go for the nursing home. Last I looked, there were no nursing homes at the IHS. But what you are saying is no different than what republicans have been saying for some time now. They would love to close the VA system down and go to private care with vouchers, sound familiar? It should because that is what they would love to do with Medicare.
I worked at Ft. Mead as a chaplain for 6 years in the early part of this millennium. I was surprised at what a full-service place it is. The staff on all levels really care for our Old Boys. I loved them. They were the best. I buried some of them too, and was always touched by the honors solemnly provided.
A van made a trip twice a day to RC to bring vets up. There was a man named X who had serious problems with mental illnesses. He lived in RC in various places. They brought X up about once a month. They got him showered, haircut, and clean clothes on him. They gave X a physical too, to be sure he was all right. He got him med refills, though his compliance was poor. In the winter they made sure X had a coat, boots, gloves, hat.
None of that was on one's job description. We just took care of him and he was able to have a decent quality of life, given his disability.
WR Old Guy knows all about that kind of thing. That's exactly the kind of thing that isn't duplicatable. That is what will likely be lost to privatization.
That being said, the Hot Springs buildings are in bad shape. I was there on a few occasions and usually wandered through them, often getting lost. They are great buildings and I love them. They are so energy inefficient! It must cost huge sums to heat, cool, keep dry, etc. I'd love to see the Evans Plunge people buy it, do a total renovation, and use it as a luxury resort. Can't you just see women and men in breezy summer clothes languidly sipping cocktails while the sun sets behind them?! So cool!
WR Old Guy, what do you think of my assessment and conclusion? Anyone?
I think that you are spot on Deb, thanks for taking care of us. If the private sector took it over, it could go on the tax rolls and still be a productive place as maybe a seasonal venue. To heat those old stone buildings is very difficult and expensive. As difficult as it is for some workers there, it is time to move on. As they are government employees, I am sure that there will be job offerings for them in other places. There is a new old soldiers home that will be in Hot Springs so the town will still have a good source of government revenue coming in and we should not loose sight on that.
Jerry, I am actually suggesting that all of us have the benefit and cost advantages of a universal system that treats all of us like US Senators or Representatives. Then, systems like the Indian Health and Veteran separate systems truly would not be needed.
It is already possible for veterans to get medical care outside the veteran's system even if costs are borne by VA. I took one of our local WWII veterans to Rapid City for surgery on cancerous skin growths just a couple weeks ago. The Veteran's system has an electronic record system that works and gets prescription information etc. around to local pharmacies and clinics. Hospitals and Clinics could have gotten that system free instead of spending millions to reinvent a good wheel.
My wife's sister worked as a registered nurse in the VA system for 30 years. She was retired for a couple of years but her MS and related medications caught up with her and she spent only a few weeks in the VA system herself before she died. Three of my uncles were beneficiaries and also victims of VA care.
Thank you for bringing an old soldier to the doctor and you are correct regarding some treatments that are done privately under government contract. I will tell you this about the VA and how it treats and takes care of us, it is much better than we can expect in the private world. A lot of us have issues that relate to PTSD for one. We do not seem to have the confidence in the private sector for them to address our needs, all of our needs. In my case, I always have the feeling that they never served so they do not quite understand a thinking process that I have. I may be wrong, but others have told me they feel the same way, so I am guessing that I may be on point. Anyway, the VA is and does a very valuable service to veterans and is needed more each day until we Americans decide that war is not the answer and those of us in the system, die off. I do not want to be passed into a society that does not respect the service that was rendered by going to a private system, a pay to play, to possibly be treated as if I really did not have insurance because they would see me as a low priority. Lets be clear, that is how it is done at present in private settings unless it is to the ER. No, we must keep the VA strong and funded, but we cannot just allow anything goes regarding facilities. In Hot Springs case, in my view, veterans can no longer afford to pay for things that will not help our health needs.
I like your idea a lot Doug. Let's run them all like the VA. VA gets meds so cheap because they can "bargain" for them.
I recall when the Bushies were playing with the Medicare prescription opportunities, that's just how they saw it - as a massive boondoggle opportunity for their Big Pharma pals. The Bushies' law specifically forbade using those giant numbers as a bargaining wedge for better prices. In fact, no bargaining of any type for medications was permitted!
Wow. Those Republicans are the Gold Standard of fiscal responsibility. I am kowtowing in awe.
Jerry, That may have been the intention at one time for there to be a joint use clinic for the National Guard and the VA and the Rapid City Clinic used to be on Camp Rapid. I think that the increased security after 9-11-2001 axed that idea. I heard that the VA was looking at the Ellsworth Hospital when the USAF elminated all in patient services but lack of easy access killed the idea.
Deb, You assessment is right on. We may know each other as I was in public safety at Ft Meade until 2004 and then moved to Patient Services until I retired in 2010. I was the primary person during the normal work day to assist families with the required legal items when a vet died as an inpatient.
One of the comments I heard from vets that used Ft Meade or Hot Springs was that they were impressed with the staff and caring that they had found lacking at VA Medical Centers in Denver, Chicago and other big city VAs. I still hear the same comments from vets today.
There are certain issues that vets face that should be handled by VA Medical Staff that are familiar with the needs of vets. Vets often have problems requiring multiple specialists to treat.
The Community Based Outreach Clinics other than Rapid City are contracted to provide primary care to vets. The clinics are on the VA computerized medical records system and serve a lot of vets. Anything outside the primary care requires a trip to the closest VA Medical Center that has the capability to provide the requested service. The point is that almost any clinic that has primary care can serve the basic primary care needs of a vet but the VA is the leader in providing a team concept to care for vets needs. The VA runs many programs including specialized mental health programs for Native Americans with ceremonies conducted by tribal spiritual leaders.
Perhaps the retirement pay for generals which exceeds their regular pay and can be $150,000 to $250,000 per year for sitting on their rear ends could be reduced to provide better care for the actual traumatized warriors.
Barry Goldwater played those benefits like a fiddle. He got extra pay as an active member of the armed forces when he was in Congress. Then right before retiring from Congress, I got the active duty changed to a special disability provision incompatible with active duty, but wonderful for adding to his retirement pay.